Butler Carolyn Goldberg, Ho Luxford Jamahal Maeng, Huang Chuan-Chin, Ejiofor Julius I, Rawn James D, Wilusz Kerry, Fox John A, Shernan Stanton K, Muehlschlegel Jochen Daniel
Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Anaesthesia and Pain Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.
Ann Thorac Surg. 2017 Oct;104(4):1325-1331. doi: 10.1016/j.athoracsur.2017.02.082. Epub 2017 Jun 1.
The association between long-term survival and aortic atheroma in cardiac surgical patients has not been comprehensively investigated. In this study we determine the relation between grade of atheroma and the risk of long-term mortality in a retrospective cohort of more than 20,000 patients undergoing cardiac operation during a 20-year period.
We included 22,304 consecutive intraoperative transesophageal and epiaortic ultrasound examinations performed at Brigham and Women's Hospital between 1995 and 2014, with long-term follow-up. The extent of atheromatous disease recorded in each examination was used for analysis. Mortality data were obtained from our institution's data registry. Mortality analyses were done using Cox proportional hazard regression models with follow-up as a time scale. We repeated the analysis in a subgroup of 14,728 patients with more detailed demographic characteristics, including postoperative stroke, queried from the institutional Society of Thoracic Surgeons database.
A total of 7,722 mortality events and 872 stroke events occurred. Patients with atheromatous disease demonstrated a significant increase in mortality across all grades of severity, both for the ascending and descending aorta. This relation remained unchanged after adjusting for additional covariates. Adjustments for postoperative stroke resulted in only minimal attenuation in the risk of postoperative mortality related to aortic atheroma.
Aortic atheromatous disease of any grade in the ascending and descending aorta is a significant long-term risk of long-term, all-cause mortality in cardiac operation patients. This association remains independent of other conventional risk factors and is not related to postoperative cerebrovascular accidents.
心脏手术患者的长期生存与主动脉粥样硬化之间的关联尚未得到全面研究。在本研究中，我们在一个回顾性队列中确定了超过20000例在20年期间接受心脏手术的患者中，粥样硬化等级与长期死亡风险之间的关系。
我们纳入了1995年至2014年期间在布莱根妇女医院连续进行的22304例术中经食管和主动脉外膜超声检查，并进行长期随访。每次检查记录的动脉粥样硬化疾病程度用于分析。死亡率数据来自我们机构的数据登记处。使用以随访为时间尺度的Cox比例风险回归模型进行死亡率分析。我们在一个包含14728例具有更详细人口统计学特征（包括术后中风）的亚组中重复了该分析，这些数据来自机构胸外科医师协会数据库。
共发生7722例死亡事件和872例中风事件。无论严重程度如何，升主动脉和降主动脉存在动脉粥样硬化疾病的患者死亡率均显著增加。在调整其他协变量后，这种关系保持不变。对术后中风进行调整后，与主动脉粥样硬化相关术后死亡风险仅略有降低。
升主动脉和降主动脉的任何等级的主动脉粥样硬化疾病都是心脏手术患者长期全因死亡的重大长期风险。这种关联独立于其他传统风险因素，且与术后脑血管意外无关。
